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Development and evaluation of a teaching and learning approach in cross-cultural care and antidiscrimination in university nursing students


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Background: Cross-cultural care and antidiscrimination are vital to ethical effective health systems. Nurses require quality educational preparation in cross-cultural care and antidiscrimination. Limited evidence-based research is available to guide teachers. Objectives: To develop, implement and evaluate an evidence-based teaching and learning approach in cross-cultural care and antidiscrimination for undergraduate nursing students. Design: A quantitative design using pre- and post-survey measures was used to evaluate the teaching and learning approach. Settings: The Bachelor of Nursing program in an Australian university. Participants: Academics and second year undergraduate nursing students. Methods: A literature review and consultation with academics informed the development of the teaching and learning approach. Thirty-three students completed a survey at pre-measures and following participation in the teaching and learning approach at post-measures about their confidence to practice cross-cultural nursing (Transcultural Self-efficacy Tool) and about their discriminatory attitudes (Quick Discrimination Index). Results: The literature review found that educational approaches that solely focus on culture might not be sufficient in addressing discrimination and racism. During consultation, academics emphasised the importance of situating cross-cultural nursing and antidiscrimination as social determinants of health. Therefore, cross-cultural nursing was contextualised within primary health care and emphasised care for culturally diverse communities. Survey findings supported the effectiveness of this strategy in promoting students' confidence regarding knowledge about cross-cultural nursing. There was no reported change in discriminatory attitudes. The teaching and learning approach was modified to include stronger experiential learning and role playing. Conclusions: Nursing education should emphasise cross-cultural nursing and antidiscrimination. The study describes an evaluated teaching and learning approach and demonstrates how evaluation research can be used to develop cross-cultural nursing education interventions.
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Development and evaluation of a teaching and learning approach
in cross-cultural care and antidiscrimination in university
nursing students
Jacqui Allen
, Lucinda Brown
, Carmel Duff
, Pat Nesbitt
, Anne Hepner
School of Nursing & Midwifery, Deakin University, 221 Burwood Highway, Burwood, Victoria, 3125 Australia
School of Psychology, Deakin University, Victoria, Australia
Koorie Unit, Bendigo TAFE, PO Box 170, Bendigo 3552, Australia
summaryarticle info
Article history:
Accepted 7 December 2012
Teaching and learning
Cross-cultural care and antidiscrimination
University nursing education
Background: Cross-cultural care and antidiscrimination are vital to ethical effective health systems. Nurses re-
quire quality educational preparation in cross-cultural care and antidiscrimination. Limited evidence-based
research is available to guide teachers.
Objectives: To develop, implement and evaluate an evidence-based teaching and learning approach in
cross-cultural care and antidiscrimination for undergraduate nursing students.
Design: A quantitative design using pre- and post-survey measures was used to evaluate the teaching and
learning approach.
Settings: The Bachelor of Nursing program in an Australian university.
Participants: Academics and second year undergraduate nursing students.
Methods: A literature review and consultation with academics informed the development of the teaching and
learning approach. Thirty-three students completed a survey at pre-measures and following participation in
the teaching and learning approach at post-measures about their condence to practice cross-cultural nursing
(Transcultural Self-efcacy Tool) and about their discriminatory attitudes (Quick Discrimination Index).
Results: The literature review found that educational approaches that solely focus on culture might not be
sufcient in addressing discrimination and racism. During consultation, academics emphasised the impor-
tance of situating cross-cultural nursing and antidiscrimination as social determinants of health. Therefore,
cross-cultural nursing was contextualised within primary health care and emphasised care for culturally
diverse communities. Survey ndings supported the effectiveness of this strategy in promoting students'
condence regarding knowledge about cross-cultural nursing. There was no reported change in discrimina-
tory attitudes. The teaching and learning approach was modied to include stronger experiential learning
and role playing.
Conclusions: Nursing education should emphasise cross-cultural nursing and antidiscrimination. The study
describes an evaluated teaching and learning approach and demonstrates how evaluation research can be
used to develop cross-cultural nursing education interventions.
© 2012 Elsevier Ltd. All rights reserved.
There is no consensus about how cross-cultural care and
antidiscrimination are most effectively taught to nursing students.
Culturally appropriate care is vital to ethical and effective health
systems; therefore, nurses require education in cross-cultural care.
Although nurse scholars emphasise the need to focus on both culture
and antidiscrimination, few studies have addressed both constructs
or provided a thorough description of their teaching and learning ap-
proaches (Campesino, 2008; Nairn et al., 2004). We aimed to address
this gap by developing, implementing and evaluating an evidence-
based teaching and learning approach in cross-cultural care and
antidiscrimination contextualised within a social model of health.
The current study was undertaken in an Australian program of
three years duration leading to a Bachelor of Nursing emphasising
holistic nursing care understood as including the social, cultural and
biological determinants of health. This program was approved by the
Nurses Board of Victoria thereby meeting the requirements for full
Nurse Education Today 33 (2013) 15921598
Corresponding author. Tel.: +61 3 9244 6960; fax: +61 3 9244 6159.
E-mail addresses: (J. Allen), (L. Brown), (C. Duff), (P. Nesbitt),
(A. Hepner).
Tel.: +61 8341 64923.
Tel./fax: +61 3 9244 6159.
Tel.: +61 3 55 654594; fax: +61 3 55633548.
Tel.: +61 0431475143; fax: +61 0354341489.
0260-6917/$ see front matter © 2012 Elsevier Ltd. All rights reserved.
Contents lists available at ScienceDirect
Nurse Education Today
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licensure as a registered nurse. The curriculum was focussed on pro-
viding students with strong foundations in the discipline of nursing
and an introduction to community nursing, mental health and acute
hospital care (Deakin University, 2004). In the nal year, the curricu-
lum emphasised advanced acute hospital care, chronic illness manage-
ment, aged care, and children's and family's care (Deakin University,
Following review, cross-cultural nursing was identied as a gap in the
curriculum and the community nursing subject required rewriting. Con-
sequently, the teaching and learning approach in cross-cultural nursing,
reported in the Methods and Development and implementation of the
teaching and learning approachsections, was established in the commu-
nity nursing subject and embedded within the social model of health.
We used the two relevant curriculum learning outcomes as a guide:
1. Explain the relationship between nursing and the social construc-
tions of health including primary health care
2. Based on available evidence create health promoting interventions
for individuals, families, and populations from culturally diverse
As the curriculum was based in holistic nursing care, we selected
the social constructivist model of health and theory of transcultural
nursing as the theoretical foundations for our teaching and learning
approach in order to focus on the importance of both culture and
antidiscrimination in nursing.
Literature Review
We understand health to be socially and culturally constructed.
Healthy people require healthy social, cultural and physical environ-
ments in addition to an absence of disease (Baum, 2011; McMurray
and Clendon, 2011). Health and medical treatment services are
contextualised within these broader social conditions as one of a
number of social determinants playing a vital role in health (Baum,
2011). Health is highly complex resulting from an interplay between
the social, cultural and biological determinants.
Previous research (Commission on the Social Determinants of
Health, 2008) has found that social and cultural determinants of health
affect health outcomes. Lack of culturally appropriate health care, dis-
crimination and racism are commonly experienced by minoritycultures
in Australia contributing to their poor health outcomes (Johnstone and
Kanitsaki, 2008). In other research on the healthy immigrant effectin
Canada, Newbold (2005) suggests that immigrants are at greater risk
of poor health than their native born counterparts because of discrimi-
nation and low socio-economic status.
Holistic care that addresses the social, cultural and biological de-
terminants of health is vital to ensuring equitable health outcomes
for all peoples. Quality cross-cultural care that explicitly targets struc-
tural barriers to health such as discrimination is necessary to achieve
health equity. Therefore, cross-cultural and antidiscrimination care, in
addition tocare targeting the social determinants of health are expected
standards of the nursing profession (ICN, 2007a, b)andexpectedcore
components of undergraduate curricula (Campesino, 2008).
In Australia, where this study was undertaken, cross-cultural care and
antidiscrimination in nursing education are particularly pertinent due to
the culturally diverse Australian community. Twenty-seven per cent of
Australians are born overseas (Australian Bureau of Statistics, 200910)
and they experience poorer health outcomes than their Anglo-Australian
counterparts (Johnstone and Kanitsaki, 2008). Australian Aboriginal
peoples comprise 2.5% of the Australian population (Australian Bureau
of Statistics, 2009) and experience extremely poor health outcomes, ev-
ident in the life expectancy gap of up to 17 years less than any other
Australians (Commonwealth of Australia, 2012). Poor health outcomes
of Australians born overseas and Australian Aboriginal peoples indicate
the socially unjust and subtle effects of discrimination in addition to
other poor social determinants of health.
Nurses are not able to directly overcome many structural barriers
to health, such as poverty and low socio-economic status. However,
nurses are able to provide culturally appropriate antidiscriminatory
health care and understand the complex effects of the social determi-
nants of health (International Council of Nurses, 2007a, b; McMurray
and Clendon, 2011). Educational preparation in cross-cultural nursing
and antidiscrimination contextualised in a social model of health is
required to meet these professional expectations. Yet, culture, anti-
discrimination and social models of health are absent from many
Australian undergraduate nursing curricula (Keleher et al., 2010;
Pinikahana et al., 2003). In part this may be due to the lack of consen-
sus regarding how cross cultural nursing should be taught.
Transcultural nursing is central to the debate among nurse aca-
demics regarding the recommended approach to teaching and learning
in cross cultural nursing. Transcultural nursing is a theory of nursing
concerned with comparing differences and similarities between c ultures
regarding caring values and life practices to predict care needs of indi-
viduals and promote culturally tting care (Leininger and McFarland,
2002). In transcultural nursing, cross-cultural care is nurses' under-
standing and application of the relevant culture's caring actions, health
care information and knowledge to effectively meet a person's health
care needs (Leininger and McFarland, 2002). Transcultural self-efcacy
is part of transcultural nursing. It refers to condence in performing
transcultural skills necessary for the nursing process: assessing, plan-
ning, implementing and evaluating culturally competent care (Jeffries,
2006). Past research has found that teaching and learning interventions
for nursing students based in transcultural nursing and transcultural
self-efcacy are effective in promoting students' condence to practise
cross-cultural care (Allen, 2010; Lim et al., 2004). However, few
studies have specically evaluated discrimination and racism in
nursing students following participation in cross-cultural educa-
tion (Allen, 2010). In one study (Hagey and Mackay, 2000), covert
racism was identied among some nursing students following
completion of cross-cultural education, suggesting that discrimina-
tory and racist beliefs are challenging to address in teaching and
learning approaches.
Research Question and Aims
How can teaching and learning in cross-cultural nursing and
antidiscrimination be supported in nursing students?
We aimed to address this question by
1. Developing and implementing an evidence-based teaching and
learning approach in cross-cultural care and antidiscrimination,
as contextualised within a social model of health
2. Evaluating students' self-report attitudes reecting transcultural
self-efcacy, and antidiscrimination before and after participating
in the teaching and learning approach
3. Providing evidence-based recommendations for curriculum
The teaching and learning approach was developed from a process
of consultation with academics and from a literature review. A quantita-
tive design using pre and post-survey measures was used to evaluate
the teaching and learning approach. The study design is summarised
in Fig. 1.
Developing the Tteaching and Learning Approach
Using the curriculum learning outcomes as our guide, we developed
the teaching and learning approach from a process of consultation
and debate to draft specic learning objectives, consider the approach
1593J. Allen et al. / Nurse Education Today 33 (2013) 15921598
to be implemented and deliberate the assessment of students' learning.
We also completed a literature review to identify evidence.
The process of consultation and debate, captured in the minutes of
meetings over 2008 and 2009, was conducted with all ve academics
with expertise in community nursing and with responsibility for the
community nursing subject, who co-authored this paper. The rst
author sent an invitation and a project proposal to the four other aca-
demics teaching the community nursing subject. All four agreed to
participate. These academics were experienced community nurses
with a range of practice, teaching and research experience in Australia
and internationally including in general district nursing, public health
nursing, school nursing, rural nursing, midwifery, and maternal and
child health nursing. All participants were Anglo-Australians, female
and aged between 40 and 55 years. All were registered nurses or reg-
istered midwives with postgraduate qualications in at least one of
the following: nursing, public health, education, psychology or mid-
wifery. Meetings took place each month over 2008 and in the rst
6 months of 2009 between participants face to face and/or by tele-
phone link up.
A circular process ensued during monthly meetings, whereby
learning objectives were drafted about how to achieve each curricu-
lum learning outcome in clear operational terms. Related discussion
points were identied, debated and negotiated. All teaching and
learning materials, activities and assessment tasks required for imple-
mentation of the teaching and learning approach were tabled for
discussion. These discussions were noted in the minutes and sent to
all participants for familiarisation prior to the next meeting (Annells
and Whitehead, 2007). Robust debate resulted during which opinions
and ideas were thoroughly tested.
This process of consultation and debate was juxtaposed against
the ndings of a literature review completed by the rst author iden-
tifying published evaluation evidence in cross-cultural care and anti-
discrimination teaching and learning. This literature review has been
published elsewhere (Allen, 2010).
Evaluation of Students' Condence in Cross-cultural Care and
All students enrolled in second semester 2009 were invited to com-
plete a postal survey before participating in the teaching and learning
approach at pre-measures and after participating in the teaching and
learning approach at post-measures. This survey evaluated their trans-
cultural self-efcacy, or condence in practising transcultural nursing
skills, and their attitudes about cultural differences. The university
student database was used to identify students and demographic infor-
mation including their age, gender, country of birth, domestic/interna-
tional status, and campus location.
The pre-survey was mailed to all enrolled students two weeks
prior to the commencement of classes in second semester 2009 with
a copy of the Plain Language Statement and an introductory letter.
Upon completion of the teaching and learning approach at the end of
second semester 2009, a post-survey was mailed to the same students.
The response rates on the pre and post-surveys were low at 13.2%.
Therefore observations made in class during teaching by academics be-
came an additional important source of information.
This survey comprised two valid and reliable self-report measures:
the Transcultural Self-efcacy Tool (TSET) (Jeffries, 2006) and the
Quick Discrimination Index (QDI) (Ponterotto et al., 2002). The TSET
(Jeffries, 2006) captures perceived condence in practising transcul-
tural nursing skills on a cognitive subscale regarding knowledge
about the ways cultural factors may affect care for people from differ-
ent cultural backgrounds, and on a practical subscale regarding con-
dence in interviewing a person about their culture (Jeffries, 2006). The
QDI (Ponterotto et al., 2002) captures prejudicial attitudes directed
towards racial minority groups. Two QDI subscales, appraising general
attitudes towards racial diversity and affective attitudes towards more
personal contact with racial diversity, were included in the survey.
Survey data were scored in accordance with the authors' guide-
lines (Jeffries, 2006; Ponterotto et al., 2002) with higher scores
reecting more of the construct. All survey data and demographic
data were entered into a Statistical Package for the Social Sciences
Version 17 (SPPS) database for analysis. Data were analysed using
SPSS Frequencies,Descriptives,Explore,Scale,and Compare Means.
Demographic data were analysed for frequencies and where data
were on a continuous scale, such as age, descriptive statistics were
computed (mean, standard deviation) and means compared using in-
dependent samples ttest. Comparisons of gender, country of birth,
domestic/international status, and campus location were undertaken
using chi square analysis for independence. Pre- and post-data on a
continuous scale (subscales of the TSET, QDI) were appraised using
paired samples t-tests.
Modication of the Teaching and Learning Approach
The academics who developed the teaching and learning approach
considered the evaluation ndings and observations they had made
during teaching and modied the approach for inclusion in subse-
quent semesters.
Consultation &
debate between
Formal discussions
each month over
Minute agendas
Literature review
learning outcomes
Developing the T&L
Survey at pre measures and
following participation in the T&L
approach at post measures
Survey measured students’:
Confidence to practice cross -
cultural nursing (Transcultural
Self-efficacy Tool)
Discriminatory attitudes (Quick
Discrimination Index)
Student evaluation of
cross-cultural nursing &
discriminatory beliefs
Academics considered
student evaluation
findings during further
meetings and
modified the T&L
approach for inclusion
in subsequent
Modification of the
T&L approach
Fig. 1. Summary of the study design.
1594 J. Allen et al. / Nurse Education Today 33 (2013) 15921598
Ethics Approvals
Approval for the pre- and post-surveys was sought and obtained
from the university ethics committee thereby safeguarding students'
anonymity and condentiality. Nursing students participated volun-
tarily in the surveys following explanation of the study using a Plain
Language Statement that provided information regarding their right
to decline to participate in the study without any effect on their studies.
They provided implied consent by returning a completed survey.
Implementation of the teaching and learning approach
The teaching and learning approach in cross-cultural care and
antidiscrimination was developed and implemented in relation to
the two curriculum learning outcomes. The literature review ndings,
learning objectives, implemented teaching and learning approach
and implemented assessment tasks are summarised in Table 1.
The social constructivist model of health and theory of transcul-
tural nursing form the frameworks underpinning the teaching and
learning approach in cross-cultural care and antidiscrimination devel-
oped and implemented in this study. The primary teaching methods
we used to implement this approach were those of class debate and
discussion, and case scenarios for experiential learning. We expected
that by including learning activities where students were required to
problem solve and provide nursing interventions to overcome cultural
and social barriers to health in each case scenario, they would learn at
an experiential level about the complexities of cross-cultural care and
antidiscrimination. We further anticipated that this process would
enable students to start to differentiate between people and their
communities, and the social conditions in which they lived. Lectures
presented relevant theoretical material. Tutorials required students to
apply knowledge to problem solve relevant case scenarios from real-
world community nursing practice. Practicum laboratories were oppor-
tunities for students to learn related skills such ascross-cultural assess-
ment and care. The teaching and learning approach was taught over
eight weeks of lectures (one hour per week), tutorials (2 h per week)
and laboratories (1 h per week) resulting in 32 h of teaching on campus
and 40 h of clinical placement; a total of 72 h of face-to-face classes/
clinical experience.
It was expected that the curriculum learning outcomes as listed in
Table 1 would be met by challenging students' attitudes and beliefs
concerning culture and diversity, Australian Aboriginal health, and so-
cial factors inuencing health including those particular to Australian
Aboriginal peoples such as colonialism and racism. We expected that
Table 1
Summary of development and implementation of teaching and learning approach in relation to curriculum learning objectives.
Literature review nding Learning objectives Implemented T&L approach Implemented assessment
Curriculum learning outcome 1
Explain the relationship between nursing and the social constructions of health including primary health care
Evidence indicates that T&L approaches
are required to promote understanding
of how social structures and determinants
including discrimination inuence health
care practices and systems
Students' understanding of health requires
challenging through discussion and
debate to:
promote understanding of the complex
social and cultural factors, in addition
to biological factors, affecting health.
develop understanding of discrimination
as a social determinant of health
develop understanding of the subtle
and powerful effects of the social
determinants of health
identify the social determinants of health
that present barriers to health for
particular peoples in the community
Classroom debate supported by readings
and group discussion, discussion
questions focussed on
What social factors inuence health?
How these social factors inuence health?
How social factors present barriers to health
for particular groups in the community?
The role of discrimination and racism in
health and health care services
Nursing as a social determinant of health
How nursing practice and interventions can
overcome some structural barriers to health
for people from
1. culturally diverse backgrounds
2. Australian Aboriginal backgrounds
Task 1:
Online multiple choice tests
sampling students' knowledge
related to each topic domain
(formative assessment,
40% weighting)
Curriculum learning outcome 2
Based on available evidence create health promoting interventions for individuals , families, and populations from culturally diverse backgrounds
Evidence indicates that T&L approaches
based in transcultural nursing are
effective in promoting cross-cultural
skills and attitudinal change
T&L approaches focussed on culture
alone may not be effective in changing
discriminatory beliefs
Evidence indicates that discriminatory
beliefs are difcult to change in nursing
and health professional students
Students' cross-cultural learning should be
supported by comparing differences and
similarities between cultures regarding
caring values and life practices to predict
care needs of individuals and promote
culturally tting care
Students' perceived condence in practising
transcultural nursing skills should be
developed and supported
Students' attitudes and beliefs concerning
culture and diversity should be identied
Students' attitudes and beliefs about
Australian Aboriginal health require
identication to promote self-reection,
appreciation of cultural differences and
understanding of discrimination.
Classroom debate, group discussions and
experiential learning techniques promoted
by the use of two real lifecase scenarios:
1. The community nursing care of an elderly
man and his wife from a migrant
background (Mr and Mrs Lipari)
2. Community nursing care in relation to
Australian Aboriginal health and the
Close the Gap policy of the Australian
Government (both case scenarios are
summarised in Table 2).
Reading material, case notes and
audio-visual material prompt discussion,
debate and self-reection.
Focus on health promoting nursing
interventions that are culturally
appropriate and overcome some
structural barriers to health in relation
to both case scenarios
Focus on each student reecting on their
own beliefs and attitudes in relation to
The care of Mr and Mrs Lipari
Care to support the health of Australian
Aboriginal communities
Task 2:
One written assignment of 1500
words regarding how community
nursing skills and roles in
cross-cultural care could inuence
the health of diverse communities
in Australia (summative
assessment, 60% weighting)
Task 3:
Students were required to complete
a one week clinical placement with
a community nurse providing care
in the community (summative
assessment, unweighted)
1595J. Allen et al. / Nurse Education Today 33 (2013) 15921598
the learning outcomes would be facilitated by classroom debate and
group discussions about two case scenarios, one about the community
nursing care of an elderly man and his wife from a migrant back-
ground and one about Australian Aboriginal health and the Close the
Gap policy of the Australian Government (summarised in Table 2).
Reading material, case notes and audio-visual material prompted dis-
cussion and debate in class. Academics expected that this approach
would promote students' self-reection regarding their own culturally
and socially determined values and biases, and also how those inherent
to health care systems and the greater community might affect nursing
care and health care for different peoples in Australia and account for
disparities in health outcomes.
The primary health care principles of access and equity guided
teaching and learning in both scenarios with emphasis on how nursing
interventions might overcome some structural barriers to health and be
culturally appropriate.
Evaluation Findings
All 251 students enrolled in the subject were invited to participate in
the pre- and post-surveys. In total, 61 students returned a pre-survey
and 55 returned a post-survey comprising response rates of 24.3% and
21.9% respectively. However, of all 251 students, only 33 completed
both a pre- and post-survey, resulting in a response rate of 13.2%.
Demographic data for the total group of 251 students are presented
in Table 3. These students were an average age of 25 years (SD 8 years,
range 1865 years). Most students (n= 230, 91.6%) were female, and
born in Australia with seven (2.8%) identifying as Aboriginal/Torres
Strait Islander Australians.
People completing a pre- and post-survey were compared with
the entire group of students on age, born in Australia/elsewhere and
campus location. There were no signicant differences between the
total group of students and those completing pre- and post-surveys
on place of birth or campus location. It was not possible to undertake
comparisons for gender because there were not enough males in the
pre/post sample (n= 4) to meet assumptions for chi square analysis.
The age of those completing pre and post-surveys (m= 29.6 years
sd= 10.3) was compared with the mean age of the entire student
group (m= 25.17 years sd = 8.158) and was found to be signicantly
different (t= 2.7 (df 37.4) p = 0.01) suggesting that older students
were more likely to complete both surveys than younger students
Pre- and post-measures were compared on all dependent variables
using pairedsamples t-tests. The alpha level was set at 0.05 signicance.
These data are presented in Table 4. The TSET cognitive subscale captur-
ing students' perceived condence (self-efcacy) in performing cross-
cultural nursing care (knowledge skills) is signicantly different
between pre- and post-measures, indicating that students consid-
ered that they had improved in this domain. All other measures
were not signicant, indicating that there was no change.
Modication of the Teaching and Learning Approach
During follow-up consultation meetings between the academics,
all evaluation ndings were considered and the teaching and learning
approach was modied. These modications included greater focus on
practical skills in cross-cultural nursing including interviewing skills
and working with interpreters, and the inclusion of experiential learn-
ing activities such as role play, during which one student played the
role of a culturally diverse client and another student played the role
of a nurse. The teaching content about Aboriginal health and written
assessment task 2 were changed to include greater focus on the social
determinants specically affecting AustralianAboriginal peoples'health
such as discrimination and racism.
In this study, a teaching and learning approach in cross-cultural
care and antidiscrimination was developed and implemented. Case
scenarios, group discussion and experiential learning were emphasised
and have been found to be effective in meeting learning outcomes in
other studies (see for example; Kaplan and Ura, 2010; Johnson and
Mighten, 2005). Evaluation ndings indicated that students' condence
in knowledge about cross-cultural nursing had improved following
completion of the teaching and learning approach. Evaluation ndings
further suggested no change in students' condence in practical skills
in cross-cultural nursing, or in students' antidiscrimination attitudes.
Academics emphasised the importance of situating cross-cultural
nursing and antidiscrimination teaching and learning in a social
model of health. This strategy was in response to the literature review
(Allen, 2010) and debate between nurse scholars in transcultural
anursing (Jeffries, 2006; Leininger and McFarland, 2002)andthose
Table 2
Summary of case scenarios 1 and 2.
Case scenario 1 Mr and Mrs Lipari
Mr Lipari is an 89-year-old man living in his own home with his wife, Marie, who is
85 years old and is his main carer. He has multiple chronic health problems. Their
local GP is concerned about their ability to remain safely in their own home and
has made a referral to community nursing. Neither Mr nor Mrs Lipari speaks English
and with exception to their GP, they are reluctant to access health services.
Case scenario 2 Close the gappolicy in relation to Australian Aboriginal health
In 2008, as the rst item of business in the Australian parliament, the then Prime
Minister Kevin Rudd made a speech apologising to the thousands of Aboriginal
people who had been forcibly removed from their families and communities prior
to the early 1970s in accordance with government laws of the time (Apology to
the Stolen Generations, Commonwealth of Australia, 2012). In this speech, Kevin
Rudd introduced new government policy aiming to substantially improve the
social determinants of health for Aboriginal peoples with the overall goal of equal
life expectancy between Aboriginal and non-Aboriginal Australians.
Table 3
Students' demographic data (N=251).
Variable Frequency n(%)
Female 230 (91.6)
Male 21 (8.4)
Country of birth
Australia 190 (75.7)
China/Hong Kong 14 (5.6)
Zimbabwe 8 (3.2)
India/Sri Lanka 6 (2.4)
Other 33 (13.1)
Domestic status
Domestic 217 (86.5)
International 34 (13.5)
Table 4
Mean scores for outcomes at pre- and post-measures (n = 33).
Scale Pre-m (sd) Post-m (sd) t Df Sig
Cognitive subscale
(n= 33)
101.21 (16.42) 108.30 (18.27) 2.165 32 0.04
Practical subscale
(n= 32)
207.28 (37.31) 218.31 (38.98) 1.76 31 0.09
Cognitive subscale
(n= 33)
23.73 (4.53) 23.09 (4.07) 1.12 32 0.27
Affective subscale
(n= 33)
15.52 (4.15) 15.85 (4.16) 0.68 32 0.50
Signicance at .05.
1596 J. Allen et al. / Nurse Education Today 33 (2013) 15921598
arguing that social structural barriers to health for culturally diverse peo-
ples also require strong emphasis in nursing education (Campesino,
2008; Papadopoulos, 2006; Culley, 2001). aPast research has found
alimited description and denition of teaching and learning ap-
proaches as implemented and evaluated in cross-cultural care and
aantidiscrimination. This study addresses this gap in the research and
provides an exemplar of a teaching and learning approach for consider-
ation by others aiming to improve undergraduate nursing curricula.
We focus our discussion here on the student evaluation ndings,
cross-cultural knowledge and practical skills (TSET), and discriminatory
beliefs (QDI) in order to support the modications to the implemented
teaching and learning approach. The nding of improved self-efcacy
regarding cross-cultural knowledge as captured by the TSET cognitive
subscale suggests developing condence in cross-cultural knowledge
among these students following participation in the teaching and learn-
ing approach. This nding replicates previous research suggesting
that transcultural nursing educational approaches are effective in devel-
oping cross-cultural nursing skills in undergraduate nursing students
(Allen, 2010). The two case scenarios, considering care requirements
for an elderly man and his wife from migrant backgrounds and health
outcomes related to the social context of Australian Aboriginal peoples,
included group discussion and problem solving in regard to the effects
of cultural background and social determinants on current health issues
and nursing care. This may have facilitated students' self-efcacy in
knowledge of the effects of culture on care as captured by the cognitive
subscale of the TSET (Jeffries, 2006). Notably, the absence of change in
the practical subscale of the TSET suggests that students' self-efcacy
concerning more practical elements of cross-cultural nursing such
as in interviewing skills required additional attention. Hence, we in-
cluded this teaching focus in the modied teaching and learning
The absence of signicant differences between pre- and post-
measures on the QDI indicated the challenge of addressing discrimina-
tory beliefs in teaching and learning. This reiterates the conclusions of
Hagey and Mackay (2000) that racist beliefs are difcult to change fol-
lowing participation in cross-cultural nursing education. Discrimina-
tion is a social determinant of health shaping the health conditions
of nursing clients as well as the attitudes, beliefs and practices of nurs-
ing students. The absence of change in discriminatory beliefs among
our students is perhaps not a surprising nding immediately following
completion of cross-cultural education given the complexities of overt
and covert discrimination within society and culture.
We developed the teaching and learning approach in the current
study to focus specically on discrimination and racism in Australian
Aboriginal health using the Close the Gapcase scenario. This scenario
and the Apology to the Stolen Generationsspeech were highly topical
in the Australian media in 2008 and 2009 and we expected that they
would stimulate discussion and strong emotional responses in rela-
tion to students' own attitudes and beliefs about discrimination and
racism. As reported by teachers in consultation meetings continuing
during the implementation of the teaching and learning approach,
the class focussed on viewing the Apology to the Stolen Generations
speech by Kevin Rudd and subsequent discussion and debate were
extremely challenging. This was due to the racist views expressed by
several students. Although challenging for teachers and many stu-
dents, this indicated that the strategy was effective in raising emotion-
ally difcult, confronting and potentially covert issues for debate and
discussion among both students and teaching staff. Many domestic
and international students directly and thoughtfully challenged the
racist views raised by some students in class. Teachers noted that stu-
dents born either in an African country or with parents from an African
country were particularly active in these discussions. Importantly,
differences in cultureand experiences of discrimination were shared
experiences for many students. The culturally diverse nature of nursing
students in many classes contributed substantially to challenging de-
bate and discussion about racism.
Academics developing the teaching and learning approach agreed
to continue with the content and focus of the class and topic about
discrimination and racism as it was considered valuable learning
enabling students to test their perspectives, beliefs and at times
taken for grantedprivileges regarding culture, race and discrimina-
tion with each other. Assessment task 2 was modied in accordance
with this nding to focus on the social and cultural determinants of
Australian Aboriginal peoples' health, and meaningful nursing inter-
ventions. We anticipated that greater emphasis on the social and
structural determinants of health for Australian Aboriginal communi-
ties and consideration of participative nursing interventions to sup-
port these communities' health would provoke further reection
and testingof internal values and beliefs about discrimination.
There are a number of limitations in the current study. Low re-
sponse rates on the survey may indicate limited interest among
these students to participate in a survey at pre- and post-measures.
The university requests students to complete online student satisfac-
tion surveys for every subject upon completion of each semester and
students may be over surveyed. Findings from the survey cannot be
claimed to have been caused by the teaching and learning approach.
Other factors may account for the change in scores on the TSET such
as learning in other subjects undertaken at the same time. The discrim-
ination scores as measured on the QDI cannot be claimed to represent
all students in this cohort.
The study described an implemented and evaluated teaching and
learning approach and demonstrates how evaluation research can be
used to develop cross-cultural nursing and antidiscrimination educa-
tion interventions. There are implications of these ndings for curric-
ulum developers and for evaluation methods. Teaching and learning
approaches in nursing education should emphasise both cross-cultural
nursing and antidiscrimination. Indigenous health issues need to be
addressed to ensure that pertinent historical factors such as those relat-
ed to colonialism and racism are made overt. Evaluation techniques to
assess student learning, attitudes and related processes require careful
attention in order to appraise teaching effectiveness. In view of the co-
vert nature of discrimination and racism, observations made during
teaching are valuable sources of information about relevant learning
processes. The study addresses a gap by explicitly evaluating both cul-
ture and antidiscrimination following cross-cultural nursing education
providing an exemplar to guide teachers.
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... Of the eleven studies selected for this review, six used a quasiexperimental design (Amerson, 2010;Jeffreys and Dogan, 2012;Grossman et al., 2012;Allen et al., 2013;Noble et al., 2014;Halter et al., 2015), and four used a mixed-methods approach (Richards and Doorenbos (2016)). Wolfe Kohlbry (2016) In all selected studies, there was a marked risk of selection bias due to the lack of a randomized selection procedure before assignment to intervention groups. ...
... Richards and Doorenbos (2016) used "Benett's Developmental Model of Intercultural Sensitivity (DMIS)" as well as "Deardorff's Process Model of Intercultural Competence (PMIC)" guide their research. Two studies chose to combine a "Social Constructivist Model of Health" with the "Theory of Transcultural Nursing" (Allen et al., 2013) or used the "Interpretative Pedagogy Theory", which mentions the "Theory of Planned Behavior" (Muir-Cochrane, 2018). Noble et al. (2014) used "Campinha-Bacote's Model of Cultural Competence" in their quasi-experimental study. ...
... Halter et al. (2015) were similarly conservative in their teaching approaches and interventions, including lectures with participation, reflective papers, cultural competence readings and journal clubs. Allen et al. (2013) used class debates and case scenarios to raise students' cultural competence. Tutorials and lectures were combined with practicums in their labs. ...
Aim This study aimed to synthesize the findings of studies evaluating educational programs providing curricular transcultural nursing education. Backgrounds Nursing care education about cultural diversity and experience with taking care of patients from different cultures and special populations are significant factors that could likely influence cultural competence. The effect of transcultural nursing education given to nursing students has been investigated by different researchers and different methods. Addressing the effects of transcultural nursing education on nursing students’ cultural awareness, knowledge and attitudes can contribute to future transcultural nursing education activities and the creation of training content. Design This study was a methodological systematic review study. Methods Methodological quality was assessed following the PRISMA guidelines. PubMed, Science Direct, APA PsycArticles, OVID, EBSCO, and Web of Science databases were searched from 2010 to 2020. The following keywords were used: “Transcultural nursing”, “education”, “curriculum”, “course”, “effectiveness”, “cultural competence”, “knowledge”, “skills”, “attitudes”, and “nursing students”. Studies published in peer-reviewed journals in English using both experimental and quasi-experimental designs were included. Results Total of 11 research papers, (n=1375) nursing students’ outputs were included in this review. Cultural competence interventions/programs were provided as part of the core theoretical courses or as elective courses. Different durations and types of teaching methods included debates, discussions, case scenarios, practicums, simulation, international learning projects, experiential learning, storytelling, and traditional teaching lectures. In ten studies, an increase in the level of culture-related competences was reported as statistically significant (p<0.05). Conclusions Limited studies have generally proven the effectiveness of transcultural nursing education provided to nursing students. Education content, training methods and training periods were not standard in the literature. More comprehensive, valid and reliable measurement tools are needed to evaluate the education provided for nursing students.
... Broad goals, specific objectives, suggested training approaches, and activities required for the improvement of cultural competency of students were developed. Second, a brief literature review was conducted, so researchers could extract and understand cultural care curricula (content, training approaches, structure, materials, timing, and evaluation methods) [7,[21][22][23][24][25][26][27][28][29][30]. Moreover, the literature review showed how to integrate cultural care into nursing educational programs. ...
... Therefore, students can communicate with individuals from other cultures [40,41]. Using a literature review and consultation with academics, Allen et al. (2013) developed the teaching-learning methods and learning objectives for nursing students' cultural care education. The teaching-learning method was modified with experiential learning and role-playing. ...
... Then, they evaluated students' learning through quantitative study using pre and post-test. The study findings supported the effectiveness of this strategy in promoting students' confidence in cultural nursing care [21]. Two meta-analyses revealed that the best way to educate cultural competence was through a variety of educational strategies, including lectures, in-depth, interactive exercises and discussions, case study analysis, genograms, presentation of articles, selected readings and web-based learning and data collection, videos, simulations, role-playing, seminar, in-service-based learning, poster presentations, interview with clients, and development of a measuring tool [26,42]. ...
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Background Due to changing population, culturally diverse clients with different perceptions of illness and health are present in healthcare settings. Therefore, it is increasingly important for nursing students to have high levels of cultural competence in order to meet diverse client needs. A training program is essential to enhance students’ cultural competence. This study aimed to design, implement, and evaluate a cultural care-training program to improve cultural competence of undergraduate nursing students. Methods This exploratory mixed methods study used six steps proposed in the Talbot and Verrinder model to design a training program. In the first step, a conventional qualitative study was conducted and 18 participants were interviewed using purposive sampling. In the second and third steps, literature review and the classic Delphi technique were used for initiation and finalization of the program. The fourth, fifth, and sixth steps were completed by implementing, monitoring, and evaluating the cultural care program (five two-hour sessions) among 73 nursing students using a quasi-experimental design. Finally, effectiveness of program was evaluated through the cultural care inventory before and 1 month after the program. Data were analyzed via SPSS25, independent samples t- test, paired t- test, chi-square test, analysis of covariance, and multivariate linear regression tests. Results A systematic model was used to identify key elements of a cultural care program, including main topics, educational objectives and contents, assignments and activities for students, teaching and evaluation methods. The curricular objectives and educational contents were implemented in five sessions to produce measurable results. The quantitative step showed that nursing students’ cultural competence in the intervention group (184.37 ± 22.43) improved significantly compared with the control group (153.19 ± 20.14) (t = 6.24, p = 0.001) after intervention. Conclusion A cultural care training program can be designed by the model applied in this study in order to improve cultural competence of nursing students. This training program will be effective if students’ learning needs, appropriate assignments, and acceptable teaching methods are addressed. Therefore, nurse educators can design comprehensive training programs to improve nursing students’ cultural competence in different cultures and contexts. This training program is highly efficient because it is applicable in many disciplines of nursing education.
... Critics of cultural competence and multicultural education concur that they do not address the underlying systems of operation (power dynamics and perceiving non-whites as "other") and further validate the assumed inferiority of the marginalized group (Bell, 2020;Garneau et al., 2018;Pon, 2009). Learning about cultural differences is not enough to transform human relations constructed in the context of power or eliminate racial discrimination and inequities (Allen et al., 2013;Iheduru-Anderson & Wahi, 2020). ...
... To support transformative learning building, the racial literacy of faculty and nursing students is essential to converse fluently about race- (Long, 2012;Ndiwane et al., 2014;Rutledge et al., 2008), immersion experiences (Edmonds, 2010), new course designs (Allen et al., 2013;Moffitt & Durnford, 2021;Mohammed et al., 2014), critical antidiscriminatory pedagogy (Garneau et al., 2018), and one-off cultural competence, multicultural education, intercultural communication workshops, or antiracist training (Majda et al., 2021;O'Connor et al., 2019;Valderama-Wallace & Apesoa-Varano, 2020). Iheduru-Anderson and Wahi (2022) cited several theoretical approaches to address racism, specifically ongoing norm-critical skill-building. ...
In the profession of nursing, whiteness continues to be deeply rooted because of the uncritical recognition of the white racial domination evident within the ranks of nursing leadership. White privilege is exerted in its ascendency and policy‐making within the nursing discipline and in the Eurocentric agenda that commands nursing pedagogy. While attention to antiracism has recently increased, antiracism pedagogy in nursing education is nascent. Pedagogical approaches in the nursing profession are essential. Because it encompasses the strategies used to transmit the science in how nurses practice and teach, which has predominantly been informed using a Eurocentric lens. This paper presents a literature review on antiracist pedagogy in nursing education, discussing how nurse educators can integrate antiracism pedagogy in nursing education, highlighting examples presented by the authors. Key terms related to antiracism are reviewed. The resultant themes from the literature review include resistance to antiracist pedagogy, managing emotional responses, and supporting transformative learning using an antiracist approach. The primary implementation of Eurocentric pedagogical approaches whiteness pervasive in nursing education must be uprooted. Antiracist and other antioppressive learning approaches must be embraced to understand the insidiousness of racial inequities and its power in sustaining structural oppression in nursing academia.
... For the academic to engage students in range of play-based learning experiences it is important to consider the scope of play sequenced through the EPR model, as well as associated strategies. Despite nursing academics accepting role-play as a useful tool to promote learning within simulations (Allen et al., 2013), embodiment and projective play are less common, however there is scope to develop these further. ...
... For example, role-play has been used to educate nursing students in an interactive way, trust games to build team relationships, and ice breaker activities, such as nurse bingo, to encourage a playful environment, are included in the top ten list of nursing games(Wilson, 2018). Role-play in nursing simulations is accepted and evidenced within the literature, particularly in simulation settings in higher education nursing programs(McAllister et al., 2013;Nilsson, 2010;Reid Searl et al., 2014;Tilbrook, Dwyer, Reid-Searl, & Parson, 2017a) Allen et al. (2013) modified an undergraduate nursing curriculum to include role-play and experiential learning to promote inclusive cross-cultural anti-discriminatory teaching approaches.McAllister et al. (2013) discuss the many creative, fun, imaginative ways simulations can be conducted using role-play approaches including puppet play. Reid utilises interpersonal theory to teach humanistic skills to students through masked education simulation, see for example, Reid-Searl (2014) on the following YouTube link ( ...
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The nursing academic, who is responsible for settingthe playful conditions, creates a safe and permissive learning environment,which in turn facilitates the student’s ability to engage in fun exploratorylearning activities. It is hypothesised that the use of a humanistic stancewith playful engagement such as, projective small world play, will facilitateoptimal teaching conditions in the higher education sector.
... It is unlikely that a single pedagogical or organizational strategy will prove successful in all settings. However, implementing integrated learning activities developed in collaboration with students through a variety of learning materials with reflective writing assignments that feature experiences of members of historically oppressed groups helps learners unpack concepts such as power and privilege and the relevance of these concepts in their lives (Allen et al., 2013;Arieli et al., 2012;& Kickett et al., 2014). ...
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Background: Systemic racism and inequity are embedded in higher education, especially in nursing. By disregarding health disparities and inequities, a hidden curriculum is endorsed, implicitly letting both instructors and students know that not addressing these subjects is acceptable. Method: Needs assessments were performed to assess faculty and student attitudes about the needs for justice, equity, diversity, and inclusion (JEDI) concepts. Using the Plan-Do-Study-Act model, the School of Nursing leadership, faculty, and students created taskforces to implement anti-oppression curricula throughout prelicensure courses. Results: Anti-oppression curricula and workshops were piloted successfully in the first semester of prelicensure nursing. Student feedback was positive with constructive suggestions. JEDI curriculum mapping was completed across the prelicensure nursing curriculum. Conclusion: JEDI concepts must be integrated across nursing curricula to identify gaps. Forming a collaboration between leadership, faculty, and students is an optimal way to proceed as they all are invested and accountable for change. [J Nurs Educ. 2022;61(8):447-454.].
... Generally, the students reported what can be described as a "casual" approach to cultural issues in the classroom, with teachers addressing the topic occasionally during lessons, frequently through examples and case-studies. Use of case-studies to illustrate cultural issues in healthcare programs has been documented in the literature [45,46]; other alternative teaching and learning strategies include international experiences [47], liaison with and participation of service users [48] and classdebate and discussion [44,49], among others. However, teacher-led classroom activities were not the only learning opportunities described by our participants, who acknowledged extracurricular and even extra-academic activities leading to improved cultural knowledge, skills and attitudes. ...
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Introduction European societies are rapidly becoming multicultural. Cultural diversity presents new challenges and opportunities to communities that receive immigrants and migrants, and highlights the need for culturally safe healthcare. Universities share a responsibility to build a fair and equitable society by integrating cultural content in the nursing curricula. This paper aims to analyze European student nurses´ experience of learning cultural competence and of working with patients from diverse cultural backgrounds. Materials and methods A phenomenological approach was selected through a qualitative research method. 7 semi-structured focus groups with 5–7 students took place at the participants’ respective universities in Spain, Belgium, Turkey and Portugal. Results 5 themes and 16 subthemes emerged from thematic analysis. Theme 1, concept of culture/cultural diversity, describes the participants’ concept of culture; ethnocentricity emerged as a frequent element in the students’ discourse. Theme 2, personal awareness, integrates the students’ self-perception of cultural competence and their learning needs. Theme 3, impact of culture, delves on the participants’ perceived impact of cultural on both nursing care and patient outcomes. Theme 4, learning cultural competence, integrates the participants’ learning experiences as part of their nursing curricula, as part of other academic learning opportunities and as part of extra-academic activities. Theme 5, learning cultural competence during practice placements, addresses some important issues including witnessing unequal care, racism, prejudice and conflict, communication and language barriers, tools and resources and positive attitudes and behaviors witnesses or displayed during clinical practice. Conclusion The participants’ perceived level of cultural competence was variable. All the participants agreed that transcultural nursing content should be integrated in the nursing curricula, and suggested different strategies to improve their knowledge, skills and attitudes. It is important to listen to the students and take their opinion into account when designing cultural teaching and learning activities.
... In fact, results from previous research have shown that health disparities between minority and non-minority groups do exist. Cultural and social determinants to health, such as unequal access to care, poverty, racism, failings of intercultural communication, and ineffective interactions between the care provider and the patient, have been identified as some of the factors underlying these [4][5][6][7][8][9][10][11][12]. ...
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Introduction: While European health policies do frequently take into consideration the ideas and experiences of their users, the voices of minority and marginalized communities are not often heard. European healthcare services must address this issue as the number of healthcare users with an MM background increases. Aim: To explore the perspectives of key stakeholders and healthcare users with an MM background on transcultural care in four European countries. Design: Qualitative phenomenological study. Methods: Semi-structured, individual interviews were conducted with stakeholders and MM users. Interviews were translated and transcribed verbatim and were carried out from February to May 2021. Descriptive statistics was used to describe the characteristics of the sample; qualitative data were analyzed thematically following Braun and Clarke's phases, resulting in 6 themes and 18 subthemes. Results: For stakeholders and MM users with long-established residence in their respective countries, cultural differences involve different family and community norms, religious beliefs, lifestyles, and habits. These components are perceived as in tension with healthcare norms and values, and they mediate in two key and related aspects of the relationship between MM users and healthcare providers: accessibility and communication. Conclusions: Communication and access to healthcare are key to MM health service users, and they are the most frequent sources of misunderstanding and conflict between them and healthcare professionals. Impact: It is important to extend the investigation of cultural issues in healthcare to stakeholders and MM users. There is no doubt that healthcare professionals should be trained in cultural competence; however, cultural competence training is not the only area for improvement. There should be a change in paradigm in healthcare services across Europe: from individual to organizational integration of culture and diversity.
... In another study, Tosun and Sinan (2020) similarly report that those who wanted to live abroad had higher intercultural awareness level and unprejudiced. The literature reports that students who go abroad through education programs have a better understanding of cultural differences (Allen et al., 2013;Ö zdemir, 2017;Türker, 2019). More than half of the students in this study received education about intercultural healthcare, and a majority of them were willing to participate in education programs about transcultural healthcare. ...
Background Students who will become health professionals should be educated according to universal standards of providing foreign patients with culturally satisfying health care, free from discrimination. Aim This study aims to identify the relationship of intercultural effectiveness and awareness with xenophobia in undergraduate nursing students and vocational schools of health services students. Method This descriptive study was conducted with undergraduate nursing students (N = 257) and vocational schools of health services students (N = 341) in a region with a high refugee population in Turkey. Data were collected through the “Intercultural Awareness Scale,” the “Intercultural Effectiveness Scale,” and the “Xenophobia Scale.” Results Of all the participants, 70.1% were females, and the mean age was 20.70 ± 2.64 years; 57% of the students were from the vocational school students, and 43% from the undergraduate nursing program. Female students had significantly higher scores in intercultural effectiveness, behavioral flexibility, xenophobia (p = 0.036, p = 0.041, p = 0.001, respectively), interaction relaxation and interactant respect (p < 0.001, p < 0.001), while male students had significantly higher intercultural awareness (p < 0.001). The median intercultural effectiveness score of the students living in the rural area was low (p = 0.044), and the median xenophobia score of the students who lived abroad was significantly lower (p = 0.032). There was a negative correlation between the Intercultural Effectiveness Scale total and Intercultural Awareness and Xenophobia Scale total mean scores (r = –0.085, r = 0.182), and there was a weak, positive correlation between the Intercultural Awareness Scale total mean scores and the Xenophobia Scale mean scores (r = 0.113). Conclusion Intercultural sensitivity is considered to be improved by including course content in the curriculum to improve students' intercultural effectiveness and awareness levels and decrease their xenophobic prejudices.
... It has been suggested that educational interventions on cultural competence improve health care students' cultural competence (Allen et al., 2013;Noble et al., 2014). A variety of educational methods have been used in the interventions, including assigned readings, lectures, documentaries, case-based discussions and international experiences (Kardong-Edgren and Campinha-Bacote, 2008;Kardong-Edgren et al., 2010;Oikarainen et al., 2019). ...
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The objective of this literature review was to identify the current evidence available on the learning of cultural competence among health care students using simulation pedagogy. An integrative literature review was conducted systematically. The CINAHL, PubMed and ERIC databases were searched for articles published between 2009 and 2019, resulting in including 17 articles in the review. The data were analyzed using descriptive synthesis. The participants of most of the studies were nursing students. The used simulation methods included low- and high-fidelity simulations, standardized patients, virtual and video-streamed simulations and role-play. The educational contents involved assessing advanced communication skills or focusing on patients' socioeconomic, cultural and environmental needs in care. The learning outcomes included knowledge of cultural competence, culturally competent communication skills, culturally competent nursing skills, self-awareness of cultural diversity and self-efficacy in diverse cultural situations. A variety of simulation methods has been used in the cultural competence education and produced several learning outcomes, including an improved understanding of cross-cultural communication and encouragement to discuss various culturally bound health issues. Further research is needed to find an effective combination of teaching methods using innovative ways to foster learning cultural competence.
... One project implemented at the University of Washington School of Nursing worked to change the climate of whiteness in academic nursing by providing faculty workshops and teaching not only didactic information about whiteness and IR, but also, how to counter against it in the process of educational delivery [43]. Allen and colleagues [75] made the connection between antidiscriminatory teaching and the teaching of crosscultural and culturally-competent care, and worked to promote an anti-discriminatory and cross-cultural curriculum at their Australian nursing program. Although Hassouneh [76] identified many challenges faced by EM faculty in implementing an anti-racist pedagogy in nursing, if developing and implementing an anti-racist pedagogy is the responsibility of nursing education leadership, this should take the pressure off of individual EM faculty. ...
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Background Unfortunately, racism and discrimination against Ethnic minority (EM) has been globalized, universally infecting industries worldwide, and the field of nursing has not been spared. In the United States (US), overt and institutionalized racism (IR) still permeates the fields of nursing, nursing leadership, and nursing education. Programs to address these disparities, and efforts by nursing professional societies and nursing education policymaking bodies to address racism in the nursing field, specifically with nursing leadership and education, have met with little success. Objective The purpose of this paper is to illustrate the existence and magnitude of racism and its impact on the fields of nursing, nursing leadership, and nursing education, and to make evidence-based recommendations for an agenda for reforming nursing education in the US. Methods A narrative literature review was conducted with a focus on pulling together the strongest evidence on which to base policy recommendations. Results Based on the available literature, we put forth five recommendations aimed at modifying nursing education in the US as a strategy to counter IR in the US in the nursing field. Conclusions Recommendations to address IR in nursing focus on nursing education, and involve implementing programs to address the lack of opportunity for both EM students and faculty in nursing, developing an anti-discriminatory pedagogy, and incorporating diversity initiatives as key performance indicators (KPIs) in the process of approval and accreditation of nursing programs.
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Health reform is increasingly targeted towards strengthening and expansion of primary health systems as care is shifted from hospitals to communities. The renewed emphasis on prevention and health promotion is intended to curb the tide of chronic disease and sustain effective chronic disease management, as well as address health inequities and increase affordable access to services. Given the scope of nurses' practice, the success of Australia's health system reforms are dependent on a nursing workforce that is appropriately educated and prepared for practice in community settings. This article reports on the results of an Australian national audit of all undergraduate nursing curricula to examine the extent of professional socialisation and educational preparation of nurses for primary health care. The results of the audit are compared with Australian nursing standards associated with competency in primary health care. The findings indicate that Australian nursing competencies are general in their approach to skills and knowledge, not specifying any particular competencies for primary health care, while undergraduate student preparation for practice in primary health and community settings is patchy and not keeping pace with reform agendas that promote expanded roles for nurses in primary health care, prevention and health promotion. The implication for nursing curriculum reform is that attention to achieving nursing graduate capacity for primary health care and health promotion is a priority.
Community Health & Wellness: Primary health care in practice, 5th Edition represents contemporary thinking and research in community health and wellness from Australia, New Zealand and the global community. It challenges students and health professionals to become more aware of the primary health care (PHC) environments in which they work in order to gain an understanding of what is socially determining the health of the individuals, families and communities within their care.
This third edition of Fran Baum's The New Public Health is the most comprehensive book available on the new public health. It offers students the opportunity to gain a sense of the scope of the new public health visions, and combines theoretical and practical material to assist students to understand the social and economic determinants of health. Based on the premise of previous editions - that the new public health offers the chance of greatly improved equity by raising health world health standards - this new edition has been fully revised to reflect recent changes in the theory and practice of the new public health. PART ONE - APPROACHES TO PUBLIC HEALTH ; 1. Understanding health - definitions and perspectives ; 2. A history of public health ; 3. The new public health evolves ; PART TWO - POLITICAL ECONOMY OF PUBLIC HEALTH ; 4. Politics and ideologies: the invisible hands of public health ; 5. Globalisation and health ; PART THREE - RESEARCHING PUBLIC HEALTH ; 6. Research for a new public health ; 7. Epidemiology and public health ; 8. Survey research methods in public health ; 9. Qualitative research methods ; 10. Planning and evaluation of community-based health promotion ; PART FOUR - HEALTH INEQUITIES: PROFILES, PATTERNS AND EXPLANATIONS ; 11. Changing health and illness profiles in the twenty first century: Global and Australian perspectives ; 12. Patterns of Health Inequities in Australia ; 13. The social determinants of health inequity ; PART FIVE - UNHEALTHY ENVIRONMENTS: GLOBAL AND AUSTRALIAN PERSPECTIVES ; 14. Global physical threats to the environment and public health ; 15. Urbanisation, population, communities and environments: Global trends ; PART SIX - HEALTHY SOCIETIES AND ENVIRONMENTS ; 16. Healthy economic policies ; 17. Sustainable infrastructure for health and well-being ; 18. Creating more equitable societies ; PART SEVEN - HEALTH PROMOTION STRATEGIES FOR ACHIEVING HEALTHY AND EQUITABLE SOCIETIES ; 19. Medical interventions ; 20. Behavioural health promotion and its limitations ; 21. Participation and health promotion ; 22. Community development in health ; 23. Healthy settings, cities, communities and organisations: Strategies for the twenty-first century ; 24. Public health policy ; PART EIGHT - PUBLIC HEALTH IN THE TWENTY-FIRST CENTURY ; 25. Linking the local, national and global ; Appendix: Public health keywords
This article summarizes normative data and psychometric evidence culled from published journal articles and dissertations for scores on the Quick Discrimination Index (J. G. Ponterotto et al., 1995; S. 0. Utsey & J. G. Ponterotto, 1999). Specific guidelines for counseling researchers and practitioners are provided. Conclusions suggest that the scores from the Index have evidenced adequate levels of validity and reliability and that the 3-factor structure is duly supported. However, as a relatively new instrument, the Index is still in its early stages regarding psychometric testing. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
New and innovative educational approaches are needed to prepare a workforce that responds to diverse needs of people from a wide variety of cultural backgrounds, languages, and worldviews. Despite some movement toward standardization of cultural curricular content, there remains a lack of consensus regarding pedagogical approaches to cultural education in nursing. An increasing number of nurse scholars have identified significant limitations in the process of cultural education in nursing and transcultural nursing theory. These critiques reflect a schism in the discipline regarding foundational theoretical perspectives and conceptualizations of culturally competent health care. This article offers a synthesis of transcultural nursing critiques that have appeared in the nursing literature over the past decade and explicates the philosophical tensions that underlie the varying pedagogical approaches to cultural education in nursing.
The student clinical experience is rich, yet challenges arise in providing experiences where leadership skills can be developed and used in nursing practice. To increase student confidence and enhance student ability to safely and effectively prioritize, delegate, and implement care for numerous patients, a simulation-based learning (SBL) experience was developed. The SBL experience involves multiple patient simulators, case study analysis, and a debriefing session. Ninety-seven senior nursing students participated in this program. Students reported through Likert surveys to either "agree" or "strongly agree" that the SBL was well organized (87%, n = 84), prompted realistic expectations (59%, n = 57), the scenarios were believable (73%, n = 71), case studies increased understanding (66%, n = 64), and that the SBL experience increased understanding of prioritizing and delegating care (69%, n = 67). Seventy-eight percent (n = 76) reported "more confidence in ability to work as a team" and 55% (n = 52) reported "more confidence in prioritizing and delegating care."